SAN FRANCISCO, October 5, 2015 – Just in time for the newest school year, schools in the state of Washington became eligible to receive Medicaid reimbursement for speech-language therapy, occupational therapy and other related services delivered online—such as those provided by PresenceLearning—just as they do for such services delivered onsite to eligible students.
Live, online delivery of services—also known as telemedicine or telehealth—is a mode of delivery that has been shown to produce the same or better results when compared to onsite delivery. Telemedicine, commonly used in healthcare settings, is recognized as effective by the American Speech Language Hearing Association (ASHA) and other professional organizations and is supported by dozens of peer-reviewed, published research studies.
Under federal mandates of the Individuals with Disabilities Education Act (IDEA), school districts are required to provide students who have special needs with special education and related services such as speech-language therapy. In spite of this requirement, a nationwide shortage of qualified clinicians and challenges particular to Washington state’s location and demographics—including long commutes to hard-to-reach schools, difficulty attracting professionals to certain areas, and serving large bilingual populations—make it difficult to appropriately staff speech-language pathology programs. Telemedicine has been a viable alternative for several years, but a lack of Medicaid reimbursement effectively penalized districts that chose to use it—even when telepractice was their only practical option. Now that telemedicine is Medicaid reimbursable, Washington schools can choose telepractice as a therapy delivery method without having to forgo Medicaid funds.
On September 24, 2015 Washington state’s Office of the Superintendent for Public Instruction issued a memo—MEMORANDUM NO. 051-15M SPECIAL EDUCATION—stating that, “Effective October 1, 2015 telemedicine will be covered by the Health Care Authority (HCA) as an allowable mode to deliver school-based service eligible for Medicaid reimbursement when services are delivered by a qualified practitioner to a student in a school setting.” The memo further stated that, “Our office is pleased that HCA is responding quickly to the recent change in the Medicaid definition of telemedicine services in order to implement the change in school-based healthcare services this school year.”
“This is a huge win for Washington schools and their students, making sure that there is equitable access to services that students need,” said Clay Whitehead, Co-founder and Co-CEO of PresenceLearning. “Washington made a smart move here, as the federal government has delegated the decision to approve online services as a valid means of delivery to the states. As such, Washington was able to help a huge number of students with a simple clarification of their policy. No complex plan review was required. A quarter of the states in the US have already made this move, and we look forward to seeing other states follow Washington’s lead.”
In April of 2015, the Centers for Medicare and Medicaid Services (CMS) issued a major clarification of federal policy regarding telemedicine reimbursement, declaring that states are no longer required to submit a separate Service Provider Agreement (SPA) for coverage of telemedicine services—if they reimburse for telemedicine services the same way they submit for face-to-face services. Now, eleven states, including Washington state, plus the District of Columbia have declared that districts may submit claims for reimbursement for live, online speech-language therapy services. Several of these states, like Washington, New Mexico and Maine, have included the full range of IEP-related services delivered via telemedicine in their Medicaid reimbursement policy clarifications.
PresenceLearning (www.presencelearning.com) is the leading telehealth network of providers of clinical services and assessments to educational organizations. The PresenceLearning care network has provided over one million sessions of live, online speech-language therapy, occupational therapy, behavioral interventions and mental health services, diagnostic services and assessments, and early childhood services for children with special needs.